Provider Demographics
NPI:1588969588
Name:TEAGUE, JOHN
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:TEAGUE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:TEXAS TECH UNIVERSITY HEALTH SCIENCES CTR
Mailing Address - Street 2:3601 4TH STREET, MS 8182
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79430-0001
Mailing Address - Country:US
Mailing Address - Phone:806-743-2981
Mailing Address - Fax:806-743-2982
Practice Address - Street 1:TEXAS TECH UNIVERSITY HEALTH SCIENCES CTR
Practice Address - Street 2:3601 4TH STREET, MS 8182
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79430-0001
Practice Address - Country:US
Practice Address - Phone:806-743-2981
Practice Address - Fax:806-743-2982
Is Sole Proprietor?:No
Enumeration Date:2011-01-21
Last Update Date:2011-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX672425367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered